Tammy Smick of Downey, sits in the bedroom of her son, Alex, who died in 2012 from a lethal combination of prescription medications while being treated at an Orange County drug treatment center. (Photo by Nick Agro, Orange County Register/SCNG)

“These legislators have blood on their hands,” said Ryan Hampton, who pushed a bill to require basic standards for sober living homes after a friend died of an overdose in one – and was outraged when language referencing sober living homes was deleted at the last minute. “I have to go back and tell his mother that business will remain as usual, and people will continue to die?”

A bill by Sen. Pat Bates, inspired by successful reforms in scandal-plagued Florida, would have kick-started a wholesale revamp of California’s notoriously lax regulation of addiction treatment. Instead, her bill languishes in suspended animation in a committee file. It essentially is dead. Another bill, by Assemblymember Sharon Quirk-Silva, tried to place a state inspector in Orange County, ground zero of the Rehab Riviera. It was gutted and now addresses police training and racial profiling. California’s Legislative session ended Friday, Aug. 31, with just a few surviving rehab reform bills making it through both chambers and advancing to the governor’s desk.

“More people will die,” said Dave Aronberg, a Florida state attorney who spearheaded Florida’s crackdown and helped Bates craft her bill. “The ignorance and apathy of some lawmakers is going to continue to cost lives.

“We didn’t have this much trouble in Florida,” he said.

Many who hoped for bolder action to protect vulnerable users and their often-desperate families are disappointed – but the stakes are too high to quit now, Bates said.

“You get frustrated,” said Bates. “But we don’t give up. We have to keep going. You start down the path again.”

Survivors

A trio of rehab-related bills has advanced to Gov. Jerry Brown’s desk, awaiting the signature that will make them law.

That, in and of itself, is a minor miracle: Of the dozens of bills on the issue introduced since 1999, only three have reached the governor’s desk – and they were vetoed by Govs. Pete Wilson, Gray Davis and Arnold Schwarzenegger, according to the California Research Bureau.

After getting out of the hospital and being in a two-week induced coma for a throat abscess in 2017, Timmy Solomon was back on the street shooting up heroin and meth. (Photo by Mindy Schauer, Orange County Register/SCNG)

Ryan Hampton

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Since 2013, at least three Above It All Treatment Center clients have died, including Matthew Maniace, 20, Terri Darling, 52, and James Dugas, 25.

Matthew Maniace volunteered at an animal shelter with his mother on Long Island, New York.

Terri Darling was was an avid horsewoman. She suffered an injury to her shoulder related to her horse in March of 2014 which required opiate pain medication. Shown above with her granddaughter. (Photo courtesy of Darling Family)

A lethal dose of heroin compared to a lethal dose of fentanyl (Bruce A. Taylor-Criminalist II/NH State Police Forensic Lab)

In April 2017 Timmy Solomon’s mood swings between euphoria and sadness after shooting heroin and crystal meth, a concoction named “goofball.” (Mindy Schauer, Staff File)

A syringe found along the Santa Ana River Trail is seen in this 2017 file photo.
(Photo by Mindy Schauer, Orange County Register/SCNG)

AB 572, by Assemblywoman Sharon Quirk-Silva, D-Fullerton, would shatter the California Department of Health Care Services’s regulatory model by stationing a single inspector in or near Costa Mesa – home to the densest concentration of licensed addiction treatment facilities in California outside of Malibu.(Photo by Paul Rodriguez, Orange County Register/SCNG)

Dave Aronberg, State Attorney for Palm Beach Co., Florida speaks to reporters at the Orange County Register about sober living homes and treatment centers in Florida. (Photo by Paul Bersebach, Orange County Register/SCNG)

One of the survivors is Assembly Bill 3162. It would require new rehab licenses to be provisional for one year; allow the state Department of Health Care Services to revoke licenses for “good cause”; increase penalties for non-compliance; require all treatment to happen at the licensed facility, as opposed to off-site; and prohibit operators who’ve had a provisional license revoked from applying for a new one for five years.

Also landing on the governor’s desk will be SB 992, by Sen. Ed Hernandez, D-West Covina. It would require that financial relationships between sober living homes and licensed treatment centers are publicly disclosed, and require centers to draft plans for what to do when residents relapse, including how they’d be supervised while under the influence of drugs or alcohol, among other reforms.

Another bill – SB 1228 by Sen. Ricardo Lara, D-Bell Gardens, the one originally championed by activist Hampton – heads to the governor’s desk as well, minus the bits trying to set minimum standards for sober living homes. The bill would now forbid licensed rehabs and addiction professionals from patient-brokering – that is, paying for patients – and let the state yank licenses and assess fines.

It does not, however, make patient-brokering a crime, and it doesn’t specify dollar fines. That’s a stark contrast to Florida, where patient-brokering is now a felony punishable by jail time and fines up to $500,000.

“If there’s no real penalty, the law is useless,” Aronberg said. “The fraudulent players in the industry know that. They’ll continue to be attracted to states like California that have weak oversight. It’s a race to the bottom.”

Lara has said that we shouldn’t criminalize something that people may not know is problematic, while still sending a message that the practice is wrong.

“Patient brokering is a crisis we have to confront in substance use treatment,” Lara said in a statement. “SB 1228 gives the state a powerful new tool to protect Californians from fraud and unethical providers who put profits over what is best for patients. SB 1228 will help level the playing field for ethical providers who are struggling to compete for patients.”

Aronberg thinks stronger action is needed.

“It’s imperative that California bring its anti-patient-brokering laws up to a higher standard. It’s also imperative that California provide some sort of guidance for oversight of sober homes,” Aronberg said. “California needs these new laws because we’ve seen evidence of rogue sober homes and corrupted drug treatment centers leaving our community for California.

“Remember, the key part of all this is that it’s for the health, safety and welfare of the residents. That’s often lost on legislators. They think it’s NIMBY or discriminatory – but it’s just the opposite. It’s about protecting the people who are seeking help and who are being exploited.”

‘Bizarre’

Addicts trying to get clean — and their families — often mistake California’s 12-step-based, non-medical rehabs for facilities that provide medical treatment, thanks in part to slick advertising. Dozens have died for want of proper medical care in facilities that would not be allowed to open in other states.

Inexperienced and unscrupulous operators have rushed in to take advantage of mandatory mental health treatment coverage required by the Affordable Care Act.

It’s easy for almost anyone to open a treatment center – regardless of criminal past – and bill insurance companies hundreds of thousands of dollars per client.

Addicts with good insurance continue to be lured here with free airline tickets, “scholarships” that cover deductibles and get paid to stay in treatment or agree to a particular kind of treatment. In August, patients willing to get opioid-blocking implants were offered thousands of dollars via Craigslist and Facebook.

“It’s, frankly, bizarre,” said Mark Mishek, president and CEO at the Hazelden Betty Ford Foundation, one of the oldest, most established – and nonprofit – treatment chains in the nation.

“I don’t get it. Given California’s aggressive enforcement of hospital regulations and long-term nursing care homes, it does seem really odd. But in this particular area, it’s like they just don’t really care.”

Weary of waiting for stronger official action, Hazelden Betty Ford has started suing in federal court businesses that hijack its name and reputation to lure patients to their own facilities.

“We hope that if we can document enough of these, we can get a state attorney general or a local U.S. Attorney or the appropriate federal agency to start clamping down,” Mishek said.

Important numbers

The difficulties making changes don’t appear to be solely a function of political money.

Since 2010, major addiction treatment, behavioral health and disability-rights organizations spent $17.5 million lobbying California legislators on pending bills, and close to $200,000 on campaign contributions, according to a Southern California News Group analysis of state data.

For a sense of scale, major health industry groups have spent about the same in a single year – more than $18 million on lobbying and close to $200,000 on campaign contributions in this session alone, according to an analysis by The Sacramento Bee.

More than 21,000 people work as substance abuse counselors and social workers in California, according to the U.S. Bureau of Labor Statistics.

About 112,000 people received treatment, according to the Substance Abuse and Mental Health Services Administration.

And someone dies in one of California’s loosely licensed residential rehabs every 14 days, according to state data.

Sunshine State fixes

With the support of Florida’s governor and attorney general, stiff new laws for addiction treatment and sober living sailed through Florida’s legislature in a single session last year with unanimous support.

Now, sober living marketers in Florida must be licensed by the state’s Division of Consumer Services. False and misleading marketing statements are illegal. Patient-brokering is a felony. License fees are higher; more training is required for workers; bars licensed facilities from referring patients to sober homes that aren’t voluntarily certified; and the state can make unannounced inspections and immediately suspend licenses.

Results have come quickly. The number of opioid deaths in Palm Beach County in the first four months of 2018 plunged 62 percent over the same period in 2017 – from 283 to 88 – reflecting a sharp decline in the number of sober living homes, Aronberg said.

California’s inaction means more people will die – and these are deaths that could have been avoided, he said.

“It’s really a tragedy. These are people who would be alive but for the fact that they had insurance and sought treatment,” Aronberg said.

Reform advocate and author Hampton agrees.

“It’s easier to open an outpatient treatment facility in our state than it is to open a barbershop,” Hampton said. “You need more licensing qualifications to cut hair and paint nails than to deal with the care of people with addiction. It’s insane.”

“I’m an optometrist, licensed by the state Board of Optometry, whose No. 1 goal is consumer protection,” Hernandez said. “It’s illegal for me to pay someone to go to a street corner and round up patients. But that’s what’s been happening in this field. …

“All these bills are designed to address these kinds of problems – but it’s not at lightning speed,” he said. “I’ve learned this in my 12 years as a legislator: The wheels of government work very slowly. But they work.”

Teri Sforza is one of the lead reporters on the OCR/SCNG probe of fraud, abuse and death in the Southern California addiction treatment industry. Our "Rehab Riviera" coverage won first place for investigative reporting from the California Newspaper Publishers Association, first place for projects reporting from Best of the West and is a finalist for the National Institute for Health Care Management Foundation's print award, competing with the New York Times, the Washington Post and ProPublica. Sforza birthed the Watchdog column for The Orange County Register in 2008, aiming to keep a critical (but good-humored) eye on governments and nonprofits, large and small. It won first place for public service reporting from the California Newspaper Publishers Association in 2010. She also contributed to the OCR's Pulitzer Prize-winning investigation of fertility fraud at UC Irvine, covered what was then the largest municipal bankruptcy in America‘s history, and is the author of "The Strangest Song," the first book to tell the story of a genetic condition called Williams syndrome and the extraordinary musicality of many of the people who have it. She earned her M.F.A. from UCLA's School of Theater, Film and Television, and enjoys making documentaries, including the OCR's first: "The Boy Monk," a story that was also told as a series in print. Watchdogs need help: Point us to documents that can help tell stories that need to be told, and we'll do the rest. Send tips to watchdog@ocregister.com.

Tony Saavedra is an investigative reporter specializing in legal affairs for the Orange County Register. His work has been recognized by the National Headliner Club, the Associated Press Sports Editors, the California Newspaper Publishers Association, the Orange County Trial Lawyers Association and the Orange County Press Club. His stories have led to the closure of a chain of badly-run group homes, the end of a state program that placed criminals in inappropriate public jobs and the creation of a civilian oversight office for the Orange County Sheriff's Department, among other things. Saavedra has covered the Los Angeles riots, the O.J. Simpson case, the downfall of Orange County Sheriff-turned felon Michael S. Carona and the use of unauthorized drugs by Olympian Carl Lewis. Saavedra has worked as a journalist since 1979 and has held positions at several Southern California newspapers before arriving at the Orange County Register in 1990. He graduated from California State University, Fullerton, in 1981 with a bachelor of arts in communication.

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